Open AccessProspective audit of carotid endarterectomy in Scotland
Author(s) -
Bradbury A. W.,
Cooper G.,
Dennis M.,
Engeset J.,
Holdsworth R.,
Pell J.,
Quin R.,
Ruckley C. V.,
Slack R.,
Stonebridge P. A.,
Welch G.
Publication year - 2000
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2000.01420-52.x
Subject(s) - medicine , carotid endarterectomy , interquartile range , perioperative , stroke (engine) , referral , prospective cohort study , general surgery , stenosis , mortality rate , audit , emergency medicine , surgery , carotid arteries , family medicine , mechanical engineering , management , engineering , economics
Abstract Background: Carotid endarterectomy (CEA) is a proven means of stroke prevention provided it is performed in appropriate patients, soon after the index ischaemic event and with low perioperative morbidity and mortality rates. This study investigated how well these conditions are being met in Scotland. Methods: This was a prospective study of all 485 CEAs performed in National Health Service hospitals between 1 September 1997 and 31 September 1998. Data collection was by four independent research nurses. Results: The median patient age was 67 (interquartile range 61–73) years; 461 patients (95 per cent) were operated on for focal symptoms, 389 of whom had a stenosis of 70 per cent or more. Some 36 per cent of patients were seen by the operating surgeon within 2 weeks of referral and 35 per cent were operated on within 1 month thereafter. The perioperative combined major stroke and death rate was 3 per cent. Operations were performed by 30 surgeons in 13 hospitals. The number of CEAs per surgeon ranged from one to 49, with ten surgeons undertaking fewer than ten operations. The number of CEAs per hospital ranged from four to 99 with only three surgeons undertaking more than 50 operations. The number of CEAs per hospital ranged from four to 99 with three hospitals undertaking 50 or more operations in the study period. Conclusion: Despite the ‘diffuse’ nature of vascular surgical services necessitated by the demography and geography of Scotland, CEA is currently being performed with a perioperative major stroke and death rate substantially lower than that reported from randomized controlled trials. However, the overall effectiveness of surgery might be improved by reducing the delays to surgery. © 2000 British Journal of Surgery Society Ltd